Form and Payment module integration

I need to have one page created for a website. It will be a form a customer can complete. After completing the form, at the bottom of the form they need to be able to select a number of service hours needed from a drop down box and a calendar date with payment calculating itself (15 hours = $150 or 20 hours =

$200). This has to be done through BB&amp;T online merchant account (think of the way PayPal works when redirected to payment) so you would need to be able to install/code it in. The information in the form needs to go to an email account and the payment needs to be processed. I need someone with positive feedback to do this as I need a trustworthy person so that I can use them over and over again. Thank you!

I need to see that you have done work like this before. This isnt a hard project. You can use a shopping cart with one item of service hours and use Authorize.net probably as BB&T Merchant Services is an Authorize.Net preferred reseller and uses it for payment modules. If you're bidding over $125, please dont bother bidding. I just have no time to do it myself. Thank you!

We have gone through the information that you have provided and understand your requirements very well. We have excellent expertise in PHP5, MYSQL, DRUPAL, JOOMLA, HTML, CSS, AJAX, JAVA, J2ME, JSP, SEO, SEM, ASP.NET, VLagi

Hi ,
Good day we are a team of Web designer and developer which has a more than 10 years of expertise in design and programming
here in the Philippines. And as we check your project we are confident to deliver allLagi

Srishti Infotech delivers a wide range of software solutions with a unique blend of experience, best practices and tools like PHP, MySQL, JSP, ASP.NET,C#.NET, VB.NET. We at Srishti Infotech believe in value-driven, lonLagi